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Tunnel for Ligamentum Teres: a Rare Variation of the Liver

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Tunnel for Ligamentum Teres: a Rare Variation of the Liver Page 1 of 2 Case Report Tunnel for ligamentum teres: a rare variation of the liver Anatomy B Satheesha Nayak, N Kumar*, S Srinivasa Rao, D Reghunathan, J Patil, S Swamy Ravindra Abstract free margin of the falciform ligament Introduction - was absent. The ligamentum teres Ligamentum teres hepatis, an embry- ing from the inferior border to the enteredThe fissure the liver for throughligamentum a tunnel teres on ological remnant derived from the leftand endthen of enters the porta its fissurehepatis extend on the the visceral surface of the liver. The obliterated left umbilical vein is visceral surface of the liver. The liga- tunnel for the ligamentum teres was - mentum teres is often used for can- situated to the left of the quadrate tum teres on the inferior surface of nulation in a variety of diagnostic - thelodged liver. on We the reportfissure herefor the an ligamen anoma- and therapeutic procedures2. Though - lous case where the ligament passed the ligament is claimed to be clini- tislobe towards (Figures this 1 tunnel.and 2). Between A small thisfis sure extended from the porta hepa Case report in the disease process and clinical - through a tunnel instead of a fissure. procedurescally insignificant cannot by be a few,overlooked. its role icalfissure left andlobe the of the tunnel, liver. the quadrate obliterated by bridging of liver tissue We report the course of ligamentum lobe extended freely into the anatom acrossThe fissure the forquadrate ligamentum and left teres lobes. was teres through an anomalous tunnel Discussion in the liver, and discuss its possible The anomalies of the liver such into a tunnel through which ligamen- as presence of additional lobes or tumThis teresbridging coursed converted to its destination.the fissure Caseclinical report significance in this article. uncommon. However, reports on the left end of porta hepatis to this tun- During the dissection classes for absence of existing lobes are not- nel.A small Lack offissure separation extended of lobes, from in the medical undergraduate students, we sure for these ligaments are scanty. early embryonic period might have noticed a rare variation on the vis- Weanomalies report hereon its one ligaments such rare or vari fis- led to this variation. ceral surface of the liver in an adult - Conclusion ment teres was transformed into a Anomalies like this can often mislead 65 years. The liver looked healthy tunnelation in through which thewhich fissure ligementum for liga the radiologists or surgeons either in andmale was cadaver of normal aged sizeapproximately and shape. diagnosis or interpretations of liver diseases. teres coursed to its final destination. Introduction The ligamentum teres also known as remnant of the left umbilical vein. It ‘round ligament of liver’ is the fibrous branch of the portal vein, within the liver.extends During from the umbilicusintrauterine to thelife, left it rich blood from the placenta to the foetusprovides1. The oxygenated ligamentum and teres nutrient- with small paraumbilical veins lie in the *Corresponding author Email: [email protected] Department of Anatomy, Melaka Manipal Figure 1: The liver with a tunnel for the ligamentum teres. RL, right lobe; Medical College (Manipal campus), Manipal LL, left lobe; PH, porta hepatis; GB, gall bladder; QL, quadrate lobe; University, Karnataka, India LT, ligamentum teres; FL, falciform ligament. Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY) Satheesha Nayak B, Kumar N, Srinivasa Rao S, Reghunathan D, Patil J, Swamy Ravindra S. Tunnel for ligamentum Competing interests: none declared. Conflict of interests: none declared. interests: none declared. Conflict of interests: Competing the final manuscript. as well read and approved design, and preparation of the manuscript, the conception, to All authors contributed rules of disclosure. ethical Ethics (AME) for Medical the Association All authors abide by For citation purposes: teres: a rare variation of the liver. OA Case Reports 2013 Sep 10;2(10):95. Page 2 of 2 Case Report the surgeon during the laparoscopic liver surgeries. References anatomy. 5th ed. Philadelphia: Lippincott Williams1. Keith LM, & Wilkins; Arthur FD.2006.p291. Clinically oriented study on the morphology and blood sup- ply2. Li of XP, the Xu falciform DC, Tan ligament HY, Li CL. and Anatomical its clini- Apr;26(2):106–9. cal significance. Surg Radiol Anat. 2003 Left sided-right portal joined round ligament3. Sanli EC, with Kurtoglu an anomaly Z, Kara A, of Uzmansel the intra D.- hepatic portal vein. Saudi Med J. 2006 Dec;27(12):1897–900. Figure 2: A closer view of the tunnel for the ligamentum teres. LL, left lobe; GB, gall bladder; QL, quadrate lobe; LT, ligamentum teres. Ahmet U, Iike Ali G. A rare variation of round4. Aysin ligament K, Ozcam of the G, Adnanliver. Int O, J BulentAnat Var. B, 2009 Jan;2:62–4. Due to the presence of this tunnel, area, which in turn might make the the demarcation between the quad- Bello A . Absence of the left lobe of the rate lobe and left lobe of the liver liver5. Abdullahi in a cadaver: DZ, caseTadros report. AA, J UsmanMed Trop. JD transformationdiagnosis difficult. into Obliterationa tunnel alters of 2010;12(1);45–7. for the ligamentum teres has been thefissure anatomy for ligamentum of the quadrate teres or lobe its reportedwas not very in previous clear. Absence studies of3–5 .fissure A case as well. Aktan et al.9, have reported tion of ligamentum teres of liver—a of liver with the presence of com- the complete absence of the quadrate case6. Ebby report. S, Ambike Webmed MV. AnatomicalCent Anat. varia2012;- - lobe in about 3.7% of individuals and 3(5):WMC003389. amentum teres has been reported by anatomical abnormality of the same Ebbyplete tunnelet al.6. Butinstead in that of fissure case the for tun lig- in 29.63% of individuals. Satheesha Niigaki M, Sakai S, Akagi S. Laparoscopic 7. Sato S, Watanabe M, Nagasawa S, nel was found on the diaphragmatic et al.10, recently reported a peculiar observations of congenital anomalies of the liver. Gastrointest Endosc. 1998 Feb; surface of the liver and the quadrate 47(2):136–40. lobe was absent. The liver is sepa- for ligamentum teres and the quad- liver with the total absence of fissure rated into the left and right lobes by rate lobe. In this case, the ligamen- for ligamentum teres: new sign of intra- the falciform and round ligaments in tum teres entered the liver through peritoneal8. Cho KC, Bakerair on SR. plain Air inradiographs. the fissure the second month of gestation. Lack its anterior surface. Joshi et al.11, have Radio logy. 1991 Feb;178(2):489–92. of separation might often result in noted various shapes of the quadrate fusion of lobes during the embryonic lobe such as triangular, rectangular Lobe and segment anomaly of the liver. period7. This could be one of the pos- and pear shaped. J9. Aktan Anat Soc ZA, India. Savas 2001;50(1):15–6. R, Pinar Y, Arslan O. sible reasons for having a tunnel for - Surekha DS, Kumar N, Anitha Guru, Conclusion 10. Satheesha BN, Snigdha M, Bincy MG, sure as observed by us. In the supine The knowledge of the possibility of et al. A peculiar liver with surgically ligamentum teres rather than a fis and radiologically important variations- a case report. Anat Cell Biol. 2013 ligamentum teres contains some air teres and presence of a tunnel in its Mar;46(1):82–4. inposition case of of pneumoperitoneum.the body, the fissure This for placeabsence could of fissurebe very for important ligamentum for air is visible in radiographs as a verti- surgeons and radiologists. The tunnel interesting observations on the sur- cally directed area of hyperlucency8. might be confused for a pathological face11. Joshi features SD, ofJoshi the SS,liver Athavale and their S. Someclini- Presence of a tunnel in place of the lig- cavity formed in the parenchyma of cal implications. Singapore Med J. 2009 ament might mask this hyperlucent the liver. This tunnel might surprise Jul;50(7):715–7. Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY) Satheesha Nayak B, Kumar N, Srinivasa Rao S, Reghunathan D, Patil J, Swamy Ravindra S. Tunnel for ligamentum Competing interests: none declared. Conflict of interests: none declared. interests: none declared. Conflict of interests: Competing the final manuscript. as well read and approved design, and preparation of the manuscript, the conception, to All authors contributed rules of disclosure. ethical Ethics (AME) for Medical the Association All authors abide by For citation purposes: teres: a rare variation of the liver. OA Case Reports 2013 Sep 10;2(10):95..
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